34DD Breast Reduction and then Pamela Anderson Implants

There is a relatively new way of providing an extreme lift on very saggy breasts.  GOOGLE Rubin Mastopexy and you will see the astonishing results using your own tissue.  It can also be tailored to allow for a limited reduction of tissue and remove a lateral chest roll if one is present.  If you do choose this route, it is doubtful you can have an augment later.

This mastopexy takes 4.5-5 hours over the usual 2.5-3 hours.  By choosing this route, you will avoid all of the risks that come with implants, including more surgeries in your future to keep an augmented breast "perfect".

There are situation like what you describe that require a reduction, lift, and augmentation. The ideal approach would be to idealie the breast from a reduction and list, then choose the implant that will produce the desired look. I will often do this simultaneously but you should be advise of potential increased risk and possible need for touch-up or revision when multiple elements are changed all at once.